Lecture 9: Intro to lower limb

Question 1

Name all major bones of lower limb from proximal to distal

Answer 1

Hip
Femur (longest in body, hip to knee)
Patella (sesamoid)
Tibia = bigger and medial, paired with fibula
Bones of foot

Question 2

Hip aka

Answer 2

Pelvis
Innominate
Os coxa

Question 3

Describe hip joint

Answer 3

Ball and socket
Between pelvic girdle and femur

Question 4

Describe bones of foot

Answer 4

Tarsals —> metatarsals (5) connected to phalanges
(Proximal —>distal)

Question 5

Describe knee joint

Answer 5

Femur, patella and tibia contribute (NOT FIBULA)

Question 6

DESCRIBE joints of foot

Answer 6

Ankle joint = clasp = talocrural joint
Intertarsal joints
Tarsometatarsal joints
Metatarso-phalangeal joints
Interphalangeal joints = hinge joints

Question 7

Describe normal lower limb posture = trunk weight

Answer 7

Trunk weight - centre of gravity passes close to lower limb joints over area a of support (feet) = minimize torques at major joints

Question 8

Describe normal lower limb posture = valgus angle

Answer 8

Of the knee
Places knees under hip joints and closer to centre of gravity
= improves walking efficiency (angle of femur as runs down knee = torque created by trunk less on knee when stand on one foot)
Centre of gravity passes through hip joint = produces les torques bc perpendicular, trunk sits on column = aligned with gravity in coronal plane
Anterior to knee and ankle joints

Question 9

Describe neutral pelvic positioning

Answer 9

Asis lines up with public tubercle in coronal plane

Question 10

Describe clinical correlate of pelvic tilt

Answer 10

Postural abnormalities of pelvis = can impact spinal curvatures (like lumbar lordosis) and contribute to lower back pain
Anterior pelvic tile = asis anteriot to pubic tubercle, accentuates lumbar lordosis = more extension torque
Posterior pelvic tilt = pubic tubercle anterior to asis = increase flexion torque

Question 11

How is lower limb musculature organized

Answer 11

Both regionally (tend to cross same joints) and functionally into groups of muscles with similar functions

Question 12

Describe gluteal region region

Answer 12

Hip abduction, extension and hip lateral rotation (axial rot)
Some muscles do medially rotate tho

Question 13

Describe medial thigh region

Answer 13

Hip adduction and extension

Question 14

Describe anterior thigh region

Answer 14

Hip flexion, knee extension (anterior to knee and hip)

Question 15

Describe posterior thigh region

Answer 15

Hip extension
Knee flexion (hamstrings)

Question 16

Describe anterior and lateral leg region

Answer 16

Small group muscles
Foot dorsiflexion = pull ankle up
Foot eversion = towards outside
Foot inversion = towards isndie
Foot joints extension - extend toes

Question 17

Describe posterior leg region

Answer 17

Knee flexion
Ankle plantarflexion (straighten foot = make parallel with bones)
Foot joints flexion

Question 18

What surrounds thigh and leg

Answer 18

Enveloped in deep fascia (epimysium) that surrounds functional groups
Septa (walls) extend deeper to further divide the groups into separate compartments

Question 19

Describe fascia lata

Answer 19

Broad sleeve
Encircle all thigh muscles
Helps with bio mechanics of muscles

Question 20

What is facia lata continuous with

Answer 20

Crural fascia = big sleeve
Helps with bio mechanics of muscles

Question 21

Describe purpose of septa in legs

Answer 21

Anchor to bone direction
Isolate muscles from each other

Question 22

Describe main blood supply to free lower limb

Answer 22

External iliac artery and its distal branches
Hip, gluteal and medial thigh region

Question 23

What also receives blood from branches of internal iliac

Answer 23

Hip, gluteal and medial thigh region

Question 24

Describe names for external iliac - as it moves down through leg

Answer 24

Changes names as travels dismally past anatomical landmarks
External iliac —inguinal lig—> femoral artery —adductor hiatus—> popliteal a
(Adductor hiatus = hole through medial muscle)

Question 25

Describr deep veins

Answer 25

Deep veins generally parallel to pairs and may be paired (2 veins for one artery)= running with (venae comitantes)

Question 26

Where do deep veins drain

Answer 26

Ultimately into ivc

Question 27

Describe dorsal venous arch

Answer 27

Right under foot skin Run up leg medially or laterally Connects to deep vein eventually

Question 28

Describe small saphenous vein

Answer 28

Runs up laterally —> goes through hole in crural fascia then drains into popliteal = runs along posterior leg and drains into popliteal vein posterior to knee (only to back of knee)

Question 29

Describe great saphenous vein

Answer 29

From drosal venous arch —> runs up leg medially, to fascia latta then drains through into femoral vein =Travels along medial leg, knee and thigh into femoral vein at saphenous opening (near inguinla region)

Question 30

Describe clinical correlate for superficial venous drainage

Answer 30

Varicose veins = some veins have valves to prevent blood back flow - especially in lower limbs With time = valves less efficient (incompetent) = allows blood to troll into veins and dilate then Enlarged walls Typically not for deep veins = bc muscles help these = avoid backflow

Question 31

What do the superficial veins drain

Answer 31

Skin areas

Question 32

Describe motor and sensory innervation to lower limb

Answer 32

Spinal levels l1-s5

Question 33

Sciatic nerve levels

Answer 33

L4-s3

Question 34

Where does bulk of innervation of lower limb come from

Answer 34

Lumbosacral plexus = l1-s4 = gives rise to some of largest and longest nerves in body (like sciatic)

Question 35

Are all dermatomes the same size

Answer 35

Nahhhh Sacral dermatomes become concentrically smaller around anus (s5 also coccygeal)

Question 36

Describe how lower limb dermatomes develop - embryonically

Answer 36

L1-s5=- spiral as move down leg because of medial rotation of leg during development (from lateral = medial) Originally feet look like hands but rotates = causes spiral banding

Question 37

Describe greater pelvis

Answer 37

False Superior to pelvic brim Contains lower abd viscera

Question 38

Describe lesser pelvis

Answer 38

True Inferior to pelvic brim Contains pelvic viscera = sex specific organs, rectum too

Question 39

Describe sex differences in pelvic girdle shape - AMAB

Answer 39

Narrow and deep Heart shaped pelvic inlet Narrow, oblong outlet Subpubic angle = 70dgereees

Question 40

Describe sex differences in pelvic girdle shape - AFAB

Answer 40

Overall wide and shallow Wide oval shaped pelvic inlet Larger round pelvic outlet Subpubic angle = 90-100 degrees

Question 41

What bones make up pelvis

Answer 41

Ilium Ischium Pubis All fuse to form hip bone

Question 42

Describe important parts of ilium bone

Answer 42

Iliac wing, body Iliac crest = superior edge iliac wing, superior border of false pelvis Anterior superior iliac spine = asis Anterior inferior iliac spine = aiis

Question 43

Describe important parts of ischium bone

Answer 43

Ischial spine (attachment for ligaments) Ischial tubersoity = sit bone Ischial ramus = connects to inf pubic ramus

Question 44

Describe important parts of pubis bone

Answer 44

Superior pubic ramus Pubic tubercle =forms pubic symphysis Inferior pubic ramus

Question 45

What does ischial spine do

Answer 45

Separates Greater sciatic notch and lesser sciatic notch - also will divide these into foramen

Question 46

Describe obturator foramen

Answer 46

Between pubis and ischium kinda

Question 47

Describe acetabulum

Answer 47

Hip joint socket Cup part

Question 48

What does sacrum have - for joint

Answer 48

Auricular surface = articulates with ilium at sacroiliac joint

Question 49

Describe joints of pelvic girdle

Answer 49

= goal is to provide robust and stable base for trunk and lower limb muscles = so most of bones are fused in adults (sacral vertebrae, hip bones) or articulate via solid joints (symphysis/syndesmosis)

Question 50

Describe adult acetabulum

Answer 50

Forms from fusion of the 3 bone s During growth up to 12y/o (afab) or 14 y/o (amab) = spaces between them are occupied by growth plates Usually very solid joint = cannot even see where fused

Question 51

Describe lumbosacral joint

Answer 51

Solid = symphysis Between l5 and s1

Question 52

Describe sacroiliac joints

Answer 52

Anterior = synovial Posterior = solid, syndesmosis

Question 53

Describe hip joints

Answer 53

Synovial = ball and socket Between femoral head and acetabulum

Question 54

Describe pubic symphysis joint

Answer 54

Solid = symphysis

Question 55

Describe sacrococcygeal joint

Answer 55

Solid = symphysis (fibrocartilage)

Question 56

What are general functions of ligaments of pelvis

Answer 56

Prevent upwards tilting of distal sacrum = pull sacrum down towards hip bones (sacrotuberous and sacrospinous ligaments) and for reinforcing sacroiliac joint (all ligaments of pelvis)

Question 57

Name ligaments of pelvis

Answer 57

Anterior sacroiliac ligaments Posterior sacroiliac ligaments Inguinal ligament Sacrospinous ligament Sacrotuberous ligament

Question 58

Describe sacrospinous ligament

Answer 58

Sacrum to ischial spine

Question 59

Describe sacrotuberous ligament

Answer 59

Sacrum/posterior ilium to ischial tuberosity

Question 60

What do sacrotuberous and sacrospinous ligaments do

Answer 60

Turn greater and lesser sciatic notches —> foramina (both ligaments needed) Also helps prevent coccyx from pushing out towards post aspect due to weight = ligaments hold onto sacrum